Provider Demographics
NPI:1093241069
Name:CENTER OF WELLNESS, LLC
Entity Type:Organization
Organization Name:CENTER OF WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-370-4226
Mailing Address - Street 1:1095 NIMITZVIEW DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4392
Mailing Address - Country:US
Mailing Address - Phone:513-370-4226
Mailing Address - Fax:513-672-2293
Practice Address - Street 1:1095 NIMITZVIEW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4392
Practice Address - Country:US
Practice Address - Phone:513-370-4226
Practice Address - Fax:513-672-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130029251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351061201Medicaid
TX412283ZN9Medicare UPIN